Latent Tuberculosis

Screen asymptomatic adults at increased risk for LTBI rather than using low-yield population-wide testing. USPSTF recommends screening populations at increased risk with moderate certainty of moderate net benefit; accurate screening tests are available, and treatment reduces progression to active tuberculosis. JAMA+2JAMAScreening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force RecommendationJAMAScreening for Latent Tuberculosis Infection in Adults: US ...PubMedScreening for Latent Tuberculosis Infection in Adults

Risk-based testing should identify patients with increased likelihood of infection and those with increased risk of progression once infected. Groups specifically identified for systematic testing in guideline summaries include persons living with HIV, household contacts of patients with active pulmonary tuberculosis, patients initiating anti-TNF therapy, patients receiving dialysis, organ or hematologic transplant candidates, and patients with silicosis. PubMed+2PubMedBackground Information and Contextual Questions - Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force - NCBI BookshelfPubMedAppendix A Table 1, Screening Recommendations of Other Groups - Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force - NCBI BookshelfPubMedTuberculosis Screening for People With Chronic Conditions - NCBI Bookshelf

Test people with HIV at diagnosis; those at high risk of ongoing tuberculosis exposure should undergo annual LTBI testing. PubMedPubMedTuberculosis Screening for People With Chronic Conditions - NCBI Bookshelf Screening before planned targeted immune modulation is disease-management testing and was outside the USPSTF primary-care screening evidence review, but remains a clinically important indication. PubMedPubMedScreening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force - NCBI Bookshelf

Use either a tuberculin skin test performed by the Mantoux method or a commercial interferon-gamma release assay for LTBI screening. PubMedPubMedScreening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force - NCBI Bookshelf For patients being considered for treatment without other known risk factors, CDC permits treatment consideration after a positive IGRA or a TST reaction measuring 15 mm or larger. CDCCDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDC

A positive screening test requires an active-tuberculosis assessment before LTBI therapy. Do not start preventive treatment until tuberculosis disease is excluded. CDC+1CDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDCCDCTreatment for Latent Tuberculosis Infection If symptoms or other findings raise concern for disease, obtain chest radiography; patients who develop symptoms suggestive of active tuberculosis during LTBI treatment also require chest radiography. PubMedPubMedTreatment of latent tuberculosis infection – An Update

Do not use a positive TST or IGRA to determine drug susceptibility. The NTCA/CDC LTBI regimens are intended for infection with Mycobacterium tuberculosis presumed susceptible to isoniazid or rifampin and do not apply when the infecting strain is known resistant to both drugs. PubMed+1PubMedGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 - PubMedCDCGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 | MMWR Drug-resistant exposure requires a regimen based on the exposure investigation and drug-resistance guidance rather than routine LTBI regimens. PubMedPubMedGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 - PubMed

NTCA and CDC preferentially recommend three short-course rifamycin-based regimens: 3 months of once-weekly isoniazid plus rifapentine (3HP), 4 months of daily rifampin (4R), or 3 months of daily isoniazid plus rifampin (3HR). ScienceDirect+3ScienceDirectGuidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020CDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDCPubMedGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 - PubMedCDCGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 | MMWR These regimens are preferred over 6 or 9 months of daily isoniazid monotherapy because they are effective, safe, and have higher completion rates. CDC+1CDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDCCDCTreatment for Latent Tuberculosis Infection

Use 6 months or 9 months of daily isoniazid (6H or 9H) when a short-course rifamycin regimen is not an option, including when clinically significant rifamycin drug interactions preclude it. CDC+1CDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDCCDCGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 | MMWR This is an alternative effective approach, not a reason to omit treatment once active disease has been excluded and the patient is an appropriate candidate. CDCCDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDC

Before prescribing rifampin or rifapentine, perform a medication-by-medication interaction review using current product labeling and authoritative interaction resources. Rifamycin-related interactions are especially consequential in patients undergoing solid-organ transplantation because rifampin and rifapentine interact with transplant immunosuppressive therapy. ScienceDirect+1ScienceDirectPrevention and management of tuberculosis in solid organ ...CDCTreatment for Latent Tuberculosis Infection For patients starting immunosuppressive therapy, coordinate LTBI treatment timing with the prescribing specialist; evidence summarized in inflammatory bowel disease populations supports simultaneous initiation in selected patients, but the regimen and timing should reflect tuberculosis risk and the immunosuppressive plan. WileyWileyReview article: latent tuberculosis in patients with ...

Evaluate every patient receiving LTBI treatment at least monthly for adherence, symptoms or signs of tuberculosis disease, medication adverse effects, and patient education needs. CDC+1CDCTreatment for Latent Tuberculosis InfectionPubMedTreatment of latent tuberculosis infection – An Update Instruct patients with possible medication adverse reactions to stop the medication and contact the treating clinician immediately. CDCCDCTreatment for Latent Tuberculosis Infection

Routine follow-up laboratory testing is not required for every patient. Obtain periodic laboratory monitoring when baseline liver enzymes are abnormal or when hepatotoxicity risk is present. PubMedPubMedTreatment of latent tuberculosis infection – An Update Interrupt treatment when transaminases exceed three times the upper limit of normal with symptoms or reach at least five times the upper limit of normal without symptoms. PubMedPubMedTreatment of latent tuberculosis infection – An Update

At each visit, recheck the active-disease screen rather than attributing constitutional or respiratory symptoms to medication effects alone. New symptoms concerning for active tuberculosis warrant chest radiography and a diagnostic transition away from the LTBI treatment pathway. CDC+1CDCTreatment for Latent Tuberculosis InfectionPubMedTreatment of latent tuberculosis infection – An Update

Give high priority for LTBI treatment to patients with known risk factors for progression who have a positive IGRA or TST result, after active tuberculosis is excluded. CDCCDCTreatment for Latent Tuberculosis Infection | Tuberculosis (TB) | CDC This includes patients whose immune status or planned immunosuppression makes progression prevention time-sensitive. PubMed+2PubMedBackground Information and Contextual Questions - Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force - NCBI BookshelfPubMedAppendix A Table 1, Screening Recommendations of Other Groups - Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force - NCBI BookshelfPubMedTuberculosis Screening for People With Chronic Conditions - NCBI Bookshelf

Treatment has a central public-health role because progression from untreated LTBI accounts for approximately 80% of U.S. tuberculosis cases. CDCCDCTreatment for Latent Tuberculosis Infection The practical treatment decision is therefore not whether preventive therapy has value, but whether active disease has been adequately excluded, the presumed organism is susceptible to a standard regimen, and a rifamycin-based option can be safely accommodated. PubMed+2PubMedGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 - PubMedCDCTreatment for Latent Tuberculosis InfectionCDCGuidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 | MMWR